L0301P78 - Cognition, Health and Illness
Cognition *refers to all of the mental processes we use *including: thinking, reasoning, judging, comparing and problem solving Decision Making *is choosing a preferred option or course of action from among several alternatives *decisions **can be minor or major **often have to be made on the basis of incomplete, uncertain or conflicting information  Cognitive Perspective: Rational Decision Making Expectancy-Value Theory *rational choices between alternatives are made based on: **how the individual perceives the probability of occurrence of each option **the value of each option to the individual *assumes that behaviour results from conscious choices made with the purpose of maximising gain and minimising loss *expectancy x value = behaviour **expectancy = strength of belief that an outcome is obtainable, probabilities ranging from 0 (impossible) to 1 (certain) **value = perceived value of a particular outcome to an individual **behaviour change = achieved with the highest possible combination of expectancy and value Examples *low expectancy x low value  = no change in behaviour **“quitting smoking is too hard”  x “I enjoy smoking”  = “I’ll continue smoking” *high expectancy x high value  = change in behaviour **“new drug has high rate of remission”  x “serious illness needing treatment”  = “change to prescribing new drug” Algorithms in Clinical Decision Making Algorithm *mechanical routine, formula or simple set of rules that can be used to solve al problems of a particular kind *used in the decisions made by health professionals **differential diagnosis ***identify higher probability diagnoses based on symptoms, signs, history and test results **selecting treatment ***algorithms guide treatment selection and are based on evidence from clinical trials and expert opinion ***flowcharts and test sequences can be used to diagnose a patient Heuristics *problem-solving strategies that are based on general rules that usually work **i.e. ‘rules of thumb’ *work faster than algorithms and are used when information is incomplete **can be helpful for decision making **however are frequently wrong Types of Heuristics *symmetry rule **symptoms = illness **no symptoms ≠ no illness *means-end analysis **decisions that allow you to achieve goals **e.g. taking paracetamol and resting while suffering from a cold virus *reasoning by analogy **decisions based on past successes **e.g. complying with the instructions of a health professional. *subgoal analysis **decisions that simplify a problem and break it down into smaller decisions. **e.g., treating individual symptoms in the absence of a diagnosis  Heuristics In Clinical Decision Making *heuristics that have been: **learnt from others **derived from the professionals’ own experience *i.e. means-end analysis and reasoning by analogy   Heuristics In Health Representativeness *decisions assume that a particular event is representative of an entire group of events *not the most reliable - can often miss details *e.g. a psychiatrist does not take the suicidal ideation of a patient seriously, as the patient has been talking about this for many years but has never acted on it. The patient suicides soon after. Availability *decisions based on information availability (i.e. how easy it is to remember or find) *e.g. a person who is of Chinese background, and has many Chinese friends, have a higher likelihood of encountering individuals for whom Chinese herbal medicines have been effective Health Beliefs *individual’s cognitions regarding health are a major influence on their health behaviour *a primary focus on the interaction between thoughts, feelings, behavioural intentions - and their relationship to actual behaviours *persistence of unhealthy behaviours in individuals indicates that decision making in choices about health is not rational *health promotion is better achieved by understanding how people’s beliefs affect their decisions **e.g. a vivid emotional story may be more persuasive than a group of statistics. *research indicates that certain sets of cognitions occur in individuals whose behaviours change which don’t occur in those whose behaviour does not change *however it cannot be concluded that the existence of the cognitions in the first place leads to the behaviour in the second place Assumptions for Theories Explaining Health Behaviour *there is a known link between a particular behaviour and an aspect of health *individuals perceive that they have control over the behaviour, are agents of change  Common-Sense Model (CSM) *provides a framework for: **identifying the contents of health threat representations **understanding how these cognitions and associated emotions motivate protective behaviour **i.e. understanding what a patient might be thinking and feeling after receiving a health threat diagnosis) *can provide targets for behaviour change, flag need for support or provision of information   Attributes of Illness Representation *i.e. how a patient understands an illness: *identity **the illness label, symptoms and physical **attributes that put one at risk **e.g., dizzy, headache, chest pain *cause **factors responsible for its occurrence **e.g., infection, tired, stress, unknown *timeline **time of onset and its expected duration **e.g. acute, cyclic or chronic *consequences **health and psychosocial outcomes **e.g. expected pain, psychosocial effects, and death *control/cure **personal and medical control over illness progression, prevention or cure **e.g. medication, surgery, early screening   Emotional Reaction to Health Threats *illness representations elicit emotional arousal such as worry and fear *both representations and emotions guide decisions to engage in protective behaviour *CSM delineates the processes that occur in cognitive and emotional systems whether the representation be an abstract belief or concrete fact **abstract vs conceptual processes **concrete vs experiential processes Symmetry Rule: Matching Labels with Symptoms Patients with Hypertension *poor adherence to medication when: **symptoms were used to guide use **perceived timeline was shorter (acute) than reality Blood Pressure Symptoms Study *undergraduate students had their BP taken, but were randomly assigned a BP reading *symptoms report **those told that their BP was high reported more symptoms (e.g. dizziness, headache) than did students who were told that their BP was normal *causal beliefs/timeline report **high-BP subjects were more likely to agree that BP was affected by being nervous, running around a lot, and outdoor temperature  Implications for Health/Illness Behaviours *interventions need to **provide interpretations for symptoms/lack of symptoms **guide modifications on illness or risk representations Imagery Influences On Health Motivations and Behaviour *images often used to explain and promote *information represented as images is: **processed rapidly **closer to the concrete, perceptual reality of experience than text/words **linked with effect (arousal of emotions) **highly accessible to recall   In Health Communication *increase accessibility, recall *elicit worry, negative affect **e.g. warning images on cigarette boxes: ***more negative emotional reactions and ∴ increases attempts to quit smoking Health Behaviour Change *changing behaviour is always difficult *people’s intentions to change do not necessarily result in change *models have been **developed that help us understand the factors involved in behaviour change **evaluated in their capacity to predict behaviour change Transtheoretical Model of Behaviour Change - Prochaska & DiClemente #'pre-contemplation' stage - the time before behaviour change is even considered #'contemplation' stage - the recognition that something is wrong and need for change #'preparation' stage - thinking about how to go about changing the behaviour #'action' stage - the time during which the change attempt is underway #'maintenance' stage - keeping the change going and dealing with relapses Criticisms *fuzzy boundaries between the stages *no specification of duration of stages *limited individual variation Health Action Process Approach Motivation Stage *intention is formed through considering: **risks of maintaining unhealthy behaviour **outcomes expectancies of the change: ***positive - e.g., better health, lower risk of disease, lower blood pressure ***negative e.g., gym membership costs, time to prepare meals, extra shopping **task self-efficacy - belief in ability to make the change and engage in the behaviour ***e.g. healthy cooking, start exercise  Volitional Stage *formation of plan for **action (Action planning) **coping with barriers and ways of overcoming them (Coping planning) *coping self-efficacy **belief in one’s ability to cope with barriers *engage in behaviour, maintain it and recover *recovery self-efficacy **belief in ability to cope with failure, lapse but also be able to get back on track *addresses the intention-behaviour gap